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Malpractice Liability Examined in Fatal DVT Case

doctor sitting in hospital hallwayThe recent case of a 38-year-old patient who suffered a fatal blood clot following a severe ankle sprain underscores the often-differing approaches courts have taken to assessing medical malpractice liability for judgment calls made by treating physicians.

Discussing surrounding these issues dates back to the nineteenth century, with standards continuing to evolve even to the present day. The case of the young Michigan coach who died following what appeared to be routine treatment for a relatively minor injury once again brings these considerations to the forefront.

Ankle sprain leads to deadly embolism

In the aforementioned case, a young former athlete and current baseball and football coach from Michigan had traveled to Lakeland, Florida to see the Detroit Tigers play in spring training exhibitions. While there, he suffered a severe ankle sprain and visited a local emergency room. The following day, he returned to Michigan and was seen by an orthopedic surgeon who performed a physical exam, took a medical history and ordered x-rays. Ultimately, the ankle was placed in a cast, but by that evening, the patient was experiencing agonizing pain that did not subside over the next several days.

On Friday of that week, the patient’s wife contacted the surgeon, telling him of the excruciating pain. She was advised that if it did not begin to wane by morning, that her husband should go to the emergency room, which he did. The orthopedic resident who saw him there split the cast, found slight pitting edema, but little more. A cast was again placed on the ankle, put the severe pain returned the next day. An appointment was made for an office visit the following morning.

At that point, the doctor split the case, re-examined the leg and found slight pitting edema. He also performed a Homan’s test, which was negative. The patient returned home and later that afternoon suffered chest pain accompanied by shortness of breath and died suddenly of a saddle embolus that was revealed through an autopsy.

Litigation focuses on physician’s judgment

As the case progressed, the plaintiff’s attorney highlighted the fact that the physician performed the Homan’s test in arguing that he should have sought immediate consultation and referral for additional investigation. It was asserted that the only reason a Homan’s test would have been done is that the surgeon was considering the possibility of a deep venous thrombosis in the differential diagnosis. Ultimately, the plaintiff’s lawyer alleged that the doctor was aware of the specific risk of DVT, yet did not respond appropriately to it.

The defense lawyer argued that serious pain is regularly associated with the sort of sprain the patient suffered and that the surgeon exercised diligence in assessing the leg’s appearance and related symptoms. The attorney asserted that the surgeon ought to enjoy immunity from liability in this case because his professional judgment did not differ from that of a reasonable and prudent orthopedic surgeon in similar circumstances.

It was argued that the overall judgment of the physician appropriately included consideration of the patient’s medical history and physical appearance and that not calling for any additional workup of a potential DVT was a reasonable decision.